35 yr old male “bad” hit in Rugby, dizziness, HA’s, vision changes, numbeness in Lshoulder, atrophy of L supraspinatus & fatigue
4 wks prior grade 2 A-C separation, X-Rays of C-Spine neg.,
Importance of asking the right questions: If atrophy of supraspinatus is of concern, which instrument would you use to determine if muscle is denervated?

48 yr old male, heel pain, limps into office after a 1 story fall.
Plain film equivocal
modality to R/O fracture?

CT

Explain findings & recommendations
Pt. says “ I don’t know if this is important of not, but..."
Broke foot/ankle/lower leg 3 yrs before
Hip/pelvis/groin/femur head/buttock?
If NO new fractures, bone scan would most likely be (-) b/c?

Breast 1° site of CA
Metastasis suspected to R kidney
Which imaging modality to image kidney, knowing the pt can not lay still for long?
Which modality to image kidney if pt is morbidly obese?

Can't lay still? CT

Morbidly Obese? Open MRI

24 yr old female falls in grocery store 2 wks before & complains of LBP
compression fracture of L2 seen on film
pt has legal counsel & seems to be looking for a “free Lunch”
You suspect it's an old fracture, how do you age the break & why do you choose that modality?

MRI, b/c bone marrow edema will show for 6 wks

Wellness practice wants to quanify components of VSC on a routine basis. How?

Not allowed to refer patients to offices in which you have vested financial interest

ACA & ICA guidelines on imaging:
full spine radiography

AP can be done on 14x36

Lateral should be taken in sections due to pt exposure

ACA & ICA guidelines on imaging:
Computer assisted mensuration

Do a separate pathology report

Discogram:

Controversial

Stages of Disc Herniation

Disc Protrusion

Commonly called a disc bulge, a disc protrusion occurs with the spinal disc and the associated ligaments remain in tact, but form an outpouching that can press against the nerves.

OR

the greatest distance, in any plane, between the edges of the disc material beyond the disc space is less than the distance between the edges of the base in the same plane.

Disc Extrusion

A disc extrusion occurs when the outer part of the spinal disc ruptures, allowing the inner, gelatinous part of the disc to squeeze out. Disc extrusions can occur with the ligaments intact, or damaged.

OR

in at least one plane, any one distance between the edges of the disc material beyond the disc space is greater than the distance between the edges of the base in the same plane, or when no continuity exists between the disc material beyond the disc spaceand that within the disc space.

Disc Sequestration

A disc sequestration occurs when the center, gelatinous portion of the disc is not only squeezed out, but also separated from the main part of the disc.

OR

Extrusion disc material has lost completely any continuity with the parent disc